Healthcare Provider Details

I. General information

NPI: 1871088245
Provider Name (Legal Business Name): BORDER CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 HORSE PEN CREEK RD
GREENSBORO NC
27410-8387
US

IV. Provider business mailing address

2721 HORSE PEN CREEK RD
GREENSBORO NC
27410-8387
US

V. Phone/Fax

Practice location:
  • Phone: 956-727-3047
  • Fax: 956-717-3630
Mailing address:
  • Phone: 956-727-3047
  • Fax: 956-717-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number222798
License Number StateNC

VIII. Authorized Official

Name: CLAUDIA G MERCADO
Title or Position: CEO
Credential: MD
Phone: 956-727-3047